Late diagnosis of attention deficit hyperactivity disorder and cocaine abuse

Introduction Adult ADHD diagnosis sometimes represents a challenge for the clinician, due to the comorbid psychiatric diseases that are often associated and which complicate de recognition of the primary symptoms of ADHD. The prevalence of ADHD in adult populations is 2’5% and it is a relevant cause of functional impairment. Objectives Presentation of a clinical case of a male cocaine user diagnosed with adult ADHD. Methods Literature review on adult ADHD and comorbid substance abuse. Results A 43-year-old male who consulted in the Emergency Department due to auditory hallucinosis in the context of an increase in his daily cocaine use. There were not delusional symptoms associated and judgment of reality was preserved. Treatment with olanzapine was started and the patient was referred for consultation. In psychiatry consultations, he did not refer sensory-perceptual alterations anymore, nor appeared any signals to suspect so, and he was willing to abandon cocaine use after a few appointments. He expressed some work concerns, highlighting that in recent months, in the context of a greater workload, he had been given several traffic tickets for “distractions.” His wife explained that he had always been a inattentive person (he forgets important dates or appointments) and impulsive, sometimes interrupting conversations. In the Barkley Adult ADHD Rating Scale he scored 32 points. He was diagnosed with adult ADHD and treatment with extended-release methylphenidate was started with good tolerance and evolution, with improvement in adaptation to his job and social environment. Since then, the patient has moderately reduced the consumption of drugs, although he continues to use cocaine very sporadically. Conclusions Early detection of ADHD and its comorbidities has the potential to change the course of the disorder and the morbidity that will occur later in adults. Comorbidity in adult ADHD is rather the norm than the exception, and it renders diagnosis more difficult. The most frequent comorbidities are usually mood disorders, substance use disorders, and personality disorders. Treatment of adult ADHD consists mainly of pharmacotherapy supported by behavioral interventions. When ADHD coexists with another disorder, the one that most compromises functionality will be treated first and they can be treated simultaneously. The individual characteristics of each patient must be taken into account to choose the optimal treatment. Disclosure of Interest None Declared

Introduction: Cognitive impairment is a well-recognized key feature of schizophrenia. However, these cognitive impairments may be worsened by alcohol consumption. Up to 80% of patients with alcohol use disorders (AUD) display cognitive impairments. Screening for those impairments with a full neuropsychological assessment may be difficult. The Brief Evaluation Alcohol-Related Neuropsychological Impairments (BEARNI) is a specific tool for screening those impairments easy to implement in in clinical practice (Ritz et al. Alcoholism: Clinical and Experimental Research 2015;39, 2249-60). To our knowledge, no previous studies have assessed the alcohol-related cognitive impairments using the BEARNI test in schizophrenia patients. Objectives: The objective of the study was to compare BEARNI mean scores between a group of schizophrenia patients with alcohol use disorders and a group of schizophrenia patients without alcohol use disorder.
Methods: 39 patients with schizophrenia and AUD (SCZ/AUD þ) (82% males, mean age 44.9 AE 11.0 years-old) and 49 patients with schizophrenia without AUD (SCZ/AUD-) (65% males, mean age 42.6 AE 11.4 years-old) consecutively included in the study, were assessed using the BEARNI test. All patients met DSM-5 criteria for schizophrenia and AUD. Demographic and clinical variables were also collected, using the Alcohol Use Disorders Identification Test (AUDIT) and the Positive and Negative Syndrome Scale (PANSS). The primary endpoint of the study was the difference in BEARNI cognitive mean scores between the SCZ/AUDþ and SCZ/AUDgroups.
Results: There was no difference between the two groups regarding demographic variables or PANSS mean scores (59.1 AE 12.8 vs 58.1 AE 14.0; t=-0.3; p=0.7). The AUDIT mean score was higher in the group of patients SCZ/AUDþ (20.6 AE 7.8 vs 1.6 AE 1.5; t=-14.7; p<0.0001). Total BEARNI and cognitive BEARNI mean scores were significantly lower in the group of patients SCZ/AUDþ compared to the group of patients SCZ/AUD-(10.6 AE 4.8 vs 12.6 AE 5.2; t=1.8, p=0.03 and 8.1 AE 3.9 vs 9.8 AE 3.6 t=2.0, p=0.04, respectively). The mean subscores of delayed verbal memory, alphabetical ordination, and alternating verbal fluency subtests were also significantly lower in the group of patients SCZ/þ group (respectively 1,0 AE 0.9 vs 1.6 AE 1.2, t= 2.5, p=0.01; 2,1 AE 1.2 vs 2.5 AE 1.1, t= 1.6, p=0.04; 3.3 AE1.5 vs 3.8 AE 1.5, t= 1.8, p=0.03). Conclusions: The present study found cognitive impairments using BEARNI test in schizophrenia patients with AUD compared to their counterparts without AUD. Screening alcohol related cognitive impairments using BEARNI could be easier in patients in schizophrenia patients with AUD than usual neurocognitive assessments Introduction: Adult ADHD diagnosis sometimes represents a challenge for the clinician, due to the comorbid psychiatric diseases that are often associated and which complicate de recognition of the primary symptoms of ADHD. The prevalence of ADHD in adult populations is 2'5% and it is a relevant cause of functional impairment.
Objectives: Presentation of a clinical case of a male cocaine user diagnosed with adult ADHD.
Methods: Literature review on adult ADHD and comorbid substance abuse. Results: A 43-year-old male who consulted in the Emergency Department due to auditory hallucinosis in the context of an increase in his daily cocaine use. There were not delusional symptoms associated and judgment of reality was preserved. Treatment with olanzapine was started and the patient was referred for consultation. In psychiatry consultations, he did not refer sensoryperceptual alterations anymore, nor appeared any signals to suspect so, and he was willing to abandon cocaine use after a few appointments. He expressed some work concerns, highlighting that in recent months, in the context of a greater workload, he had been given several traffic tickets for "distractions." His wife explained that he had always been a inattentive person (he forgets important dates or appointments) and impulsive, sometimes interrupting conversations. In the Barkley Adult ADHD Rating Scale he scored 32 points. He was diagnosed with adult ADHD and treatment with extendedrelease methylphenidate was started with good tolerance and evolution, with improvement in adaptation to his job and social environment. Since then, the patient has moderately reduced the consumption of drugs, although he continues to use cocaine very sporadically. Conclusions: Early detection of ADHD and its comorbidities has the potential to change the course of the disorder and the morbidity that will occur later in adults. Comorbidity in adult ADHD is rather the norm than the exception, and it renders diagnosis more difficult. The most frequent comorbidities are usually mood disorders, substance use disorders, and personality disorders. Treatment of adult ADHD consists mainly of pharmacotherapy supported by behavioral interventions. When ADHD coexists with another disorder, the one that most compromises functionality will be treated first and they can be treated simultaneously. The individual characteristics of each patient must be taken into account to choose the optimal treatment.

EPP0424
Clinical overlap between functional neurological disorders and autism spectrum disorders: a preliminary study Introduction: Functional neurological disorders (FNDs) and autism spectrum disorders (ASDs) share common features in terms of deficits in emotion regulation and recognition, sensory sensitivity, proprioception and interoception. Nevertheless, few studies have assesed teir overlap. Objectives: Aims of the present study were: (i) to assess the prevalence of autistic traits in a sample of adult patients with FNDs and (ii) to assess the prevalence of FNS in a sample of adult individuals with ASDs without intellectual disabilities; in this sample, we also evaluated the presence of a possible association between sensory sensitivity and FNS. Methods: We recruited 21 patients with FNDs, 30 individuals with ASDs without intellectual disabilities and 45 neurotypical adults (NA). Participants completed: the Autism Quotient (AQ); the Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R); and a questionnaire assessing functional neurological symptoms (FNS). ASDs participants also completed the Sensory Perception Quotient-Short Form (SPQ-SF35), assessing sensory sensitivity. Results: In the FNDs sample, no patient scored above the clinical cut-off at the AQ and the 19% scored above the cut-off at the RAADS-R, a prevalence similar to the one we found in NA (15.6%; both p > 0.05). The 86.7% of participants with ASDs reported at least one FNS, a prevalence significantly higher than the NA one (35.6%, p < 0.001). In the ASDs sample, tactile hypersensitivity was found to be a risk factor for functional weakness (OR = 0.74, p = 0.033) and paraesthesia (OR = 0.753, p = 0.019). Conclusions: In conclusions, FNDs individuals did not present autistic traits more than NA, but ASDs individuals presented a higher number of FNSs than NA; this rate was associated with higher sensory sensitivity, especially in the touch domain.

EPP0425
Quality of life and psychosocial adjustment: the moderator role of anxiety symptoms in persons with temporal lobe epilepsy due to hippocampal sclerosis Introduction: Persons with temporal lobe epilepsy due to hippocampal sclerosis (TLE-HS) have a high frequency of psychiatric disorders, namely depression and anxiety. In addition, poor quality of life (QOL) and impairments in psychosocial adjustment are frequently reported. Despite the increasing number of studies aiming to identify predictors of poorer QOL, the role of depressive and anxiety symptoms remains poorly understood. Objectives: This study aimed to evaluate: (1) if psychosocial adjustment predicts worse QOL; (2) the relationship between psychosocial adjustment and QOL by concurrently examining the role of depressive and anxiety symptoms. Methods: Participants: Thirty-five persons with TLE-HS ranging from 18 to 60 years old (mean age 39.82 SD 9.05; 20 men 57.14%) followed in a tertiary outpatient center underwent neurologic and psychiatric assessments. Assessments: The psychiatry interview was performed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID). Psychosocial adjustment was assessed with the total score of the Social Adjustment Scale (SAS) (SAS Overall). The QOL was evaluated by the total score of the Quality of Life in Epilepsy-31 Inventory (Overall QOLIE-31), the most